2022 Notable Payer News in Review
January – Mark Cuban’s Cost Plus Drug Company
Billionaire Mark Cuban sat down with @CynthiaMcFadden to discuss his plan to change everything about prescription drug prices in America.
Cuban started a company that provides generic medications at a low cost by bypassing insurers and middlemen: https://t.co/Uu9wt3sqck
— NBC Nightly News with Lester Holt (@NBCNightlyNews) December 21, 2022
June – Anthem changes name to Elevance Health, Inc. (NYSE Ticker Symbol — ELV) effective June 28, 2022.
July – New requirement for payers – Making pricing information available to the public rule effective July 1, 2022
By plan or policy years beginning on or after January 1, 2023, most group health plans and issuers of group or individual health insurance coverage are required to disclose personalized pricing information for all covered items and service to their participants, beneficiaries, and enrollees through an online consumer tool, or in paper form, upon request. Cost estimates must be provided in real-time based on cost-sharing information that is accurate at the time of the request.
October – The Inflation Reduction Act Lowers Health Care Costs for Millions of Americans
Oct – Medicare will be able to negotiate directly with drug manufacturers to lower the price of some of the costliest single-source brand-name Medicare Part B and Part D drugs.
October – UnitedHealth completes acquisition of Change Healthcare
UnitedHealth Group (@UnitedHealthGrp) said its health services unit has completed the acquisition of Change Healthcare(@Change_HC), ending more than a year of uncertainty due to anti-competitive concerns.
October – CMS cracks down on Advantage TV Ads
The Centers for Medicare and Medicaid Services (CMS) is cracking down on misleading and confusing advertisements for Medicare Advantage (MA) and Medicare Part D prescription drug plans. In the new year, MA organizations and Part D drug plans will not be allowed to air TV advertisements before CMS has approved them, according to Kathryn Coleman, director of the Medicare Drug & Health Plan Contract Administration Group.
December – ACA Enrollment
The Biden-Harris Administration announced that Affordable Care Act (ACA) Marketplace enrollment continues to move at a fast pace–nearly 5.5 million people have selected an Affordable Care Act (ACA) Marketplace health plan nationwide since the start of the 2023 Marketplace Open Enrollment Period.
December – Courts rules against Blue Cross Illinois Discriminated Against Transgender Patients
A lawsuit accusing Blue Cross Blue Shield of Illinois of violating an anti-discrimination provision of the Affordable Care Act by refusing to cover a transgender teenager’s gender-affirming care through an employer plan it administers can go forward as a class action, a federal judge ruled.
December – Humana, TriWest Win $136B in DHA T-5 Tricare Managed Care Support Contracts
Humana (@Humana) and TriWest Healthcare Alliance won $136 billion in contracts from the Defense Health Agency to provide managed care support services for service personnel, retirees and their families in the East and West regions in the U.S. as part of the Tricare program.
December – CMS proposes changes to prior authorizations
As part of the Biden-Harris Administration’s ongoing commitment to increasing health data exchange and investing in interoperability, the Centers for Medicare & Medicaid Services (@CMSGov) issued a proposed rule that would improve patient and provider access to health information and streamline processes related to prior authorization for medical items and services.
December – Blue Cross Blue Shield of Massachusetts Signs Groundbreaking Value-Based Payment Contracts Incorporating Equity Measures
Blue Cross Blue Shield of Massachusetts announced a milestone in its commitment to ensuring access to high-quality, affordable and equitable care. The not-for-profit health plan is the first in Massachusetts – and among the first in the nation – to create a financial payment model rewarding health systems and physicians for eliminating racial and ethnic inequities in care, with a goal of improving health care for all 2.9 million Blue Cross members.
Predictions and Trends
What will health care look like in 2023? Blue Shield Executives Predict a Revitalization
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Health Trends Shaping Benefits in 2023
What are some of the key trends that will shape employer-provided healthcare in the coming year and beyond? Mercer Marsh Benefits surveyed 226 insurers across 56 countries for its 2023 Health Trends Survey, which offers some insights.
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Affordability a top trend to watch in health for 2023
A heightened focus on affordability is among the seven health and well-being Trends to Watch in 2023, according to Business Group on Health. Other top trends include a greater shift toward health equity and the ongoing need for health and well-being programs that help employees navigate life’s stressors.
Best Health Insurance Companies Of January 2023
Health insurance is vital to your well-being and your wallet, but comparing health insurance companies isn’t straightforward. Forbes (@ForbesAdvisor) evaluated large, small and regional health insurance providers to find the best health insurance companies across the country. See their top picks.